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Mataboge P, Mthimkhulu N, Kutywayo A, Martin CE, Mazibuko M, Kwatsha K, Makalela N, Briedenhann E, Butler V, Bothma R, Mullick S. Preferences, educational messaging, and demand creation channels for multipurpose-prevention technologies (MPTs) among women in South Africa. BMC Public Health 2023; 23:2090. [PMID: 37880628 PMCID: PMC10598950 DOI: 10.1186/s12889-023-16904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND South African women, including female sex workers (FSWs), are disproportionately affected by HIV, experience a high unmet need for contraception and high rates of sexually transmitted infections (STIs). Products that address the interlinked risk between HIV, unplanned pregnancy, and other STIs are needed. There are several multipurpose-prevention technologies (MPTs) in development, aimed at preventing both HIV and pregnancy. This study aimed to explore educational messaging and demand creation channels to improve the potential uptake of a hypothetical MPT implant, using participatory action research. It also aimed to look at product and service provision attributes preferred by potential end users. METHODS Between July and August 2022, 303 PrEP-eligible adolescent girls and young women (AGYW) (18-24 years), women > 24 years, and FSW's (≥ 18 years) participated in 4-hour workshops, where they were asked about their ideal messaging and demand creation channels and their preferences for different attributes of an MPT implant. Quantitative descriptive analysis was conducted to determine the frequency and ranking for each demand creation message, channel, and each product and service provision attribute, by population group. A chi-square test was used to assess MPT implant characteristics associated with age. Qualitative data were analysed using deductive and thematic analysis. RESULTS A total of 104 AGYW, 157 women > 24 years, and 42 FSWs participated in the PAR workshops. Participants preferred demand creation messages that were empowering, motivational and encouraged body autonomy. The use of slang was popular. Community radio stations and newspapers, social media, and information at hospitals and clinics were participants' preferred MPT demand creation channels because they were easily accessible. Providing long-term and dual HIV and pregnancy protection, receiving implant services at the local clinic, manageable side effects, discreet and private implant, and numbing the area before insertion and removal, were the most preferred product and service provision attributes. CONCLUSION Early considerations for women's product preferences are key to product development. Educational messaging around the MPT implant should be empowering and in local languages, this may motivate women to learn more about it and use it. Multiple demand creation channels should be used to engage both young and older populations, which may ensure better reach.
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Affiliation(s)
- Paballo Mataboge
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nqaba Mthimkhulu
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Kutywayo
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E Martin
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mbali Mazibuko
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Khanyiswa Kwatsha
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nthabiseng Makalela
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elmari Briedenhann
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vusile Butler
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rutendo Bothma
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hendrickson C, Hirasen K, Mongwenyana C, Benade M, Bothma R, Smith C, Meyer J, Nichols B, Long L. Costs and outcomes of routine HIV oral pre-exposure prophylaxis implementation across different service delivery models and key populations in South Africa. medRxiv 2023:2023.08.14.23294055. [PMID: 37645864 PMCID: PMC10462215 DOI: 10.1101/2023.08.14.23294055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Oral pre-exposure prophylaxis (PrEP) is a highly efficacious biomedical HIV prevention tool, yet despite being recommended by the World Health Organization (WHO) since 2015, uptake and persistence remain limited in much of the world, including sub Saharan Africa (SSA). There is a dearth of evidence-based interventions to improve PrEP uptake and persistence in SSA, and the full costs of PrEP programs implemented in routine care settings remain largely unknown. This study aimed to evaluate the cost of delivery of daily oral PrEP, and associated outcomes, to different key and priority populations across different service delivery models (SDMs) in South Africa. Methods We conducted bottom-up micro-costing of PrEP service delivery from the provider perspective within twelve urban SDMs providing routine PrEP services to various key and propriety populations in Gauteng and KwaZulu-Natal provinces in South Africa. The SDMs included in-facility and outreach models that focused on men who have sex with men (MSM), female sex workers (FSW) and adolescent girls and young women (AGYW). We identified all within- and above-facility activities supporting PrEP delivery, obtained input costs from program budgets, expenditure records and staff interviews, and determined individual resource usage between February 2019 and February 2020 through retrospective medical record review. Our primary outcome was PrEP coverage at six months (defined as having sufficient PrEP drug dispensed at the last visit to be covered at six months post PrEP-initiation). A subset (N=633) of all enrolled subjects had the potential for 12 months of follow-up and were included in a 12-month outcome analysis. We report the cost per client initiated on PrEP in 2021 United States Dollars (USD). Findings We collected medical record data from 1,281 people who initiated PrEP at 12 SDMs between February and August 2019 and had at least six months of potential follow-up. The average number of visits was 2.3 for in-facility models and 1.5 for outreach models and 3,086 months of PrEP was dispensed. PrEP coverage at six months varied greatly across SDMs, from 41.8% at one MSM-focused fixed clinic to 0% in an MSM-focused outreach model. In general, in-facility programs had higher six-month coverage than outreach programs. Across all SDMs with PrEP clients with potential for 12 months of follow-up (n=633), PrEP coverage at 12 months was 13.6%, with variability between SDMs. The average six-month cost per client initiated on PrEP ranged from $29 to $590, with higher average costs generally observed for the in-facility programs ($152 in-facility versus $84 for outreach). The average monthly cost per PrEP client who had six-month PrEP coverage ranged from $18 to $160 dependent on SDM. Interpretation This study is an important addition to the PrEP outcome and cost literature in the SSA region. Results show that costs and outcomes vary considerably across different SDMs and populations in real world PrEP programs and provide crucial information for further scale-up of the oral PrEP program in South Africa and the greater SSA region.
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Stone J, Bothma R, Gomez GB, Eakle R, Mukandavire C, Subedar H, Fraser H, Boily M, Schwartz S, Coetzee J, Otwombe K, Milovanovic M, Baral S, Johnson LF, Venter WDF, Rees H, Vickerman P. Impact and cost-effectiveness of the national scale-up of HIV pre-exposure prophylaxis among female sex workers in South Africa: a modelling analysis. J Int AIDS Soc 2023; 26:e26063. [PMID: 36807874 PMCID: PMC9939943 DOI: 10.1002/jia2.26063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION In 2016, South Africa (SA) initiated a national programme to scale-up pre-exposure prophylaxis (PrEP) among female sex workers (FSWs), with ∼20,000 PrEP initiations among FSWs (∼14% of FSW) by 2020. We evaluated the impact and cost-effectiveness of this programme, including future scale-up scenarios and the potential detrimental impact of the COVID-19 pandemic. METHODS A compartmental HIV transmission model for SA was adapted to include PrEP. Using estimates on self-reported PrEP adherence from a national study of FSW (67.7%) and the Treatment and Prevention for FSWs (TAPS) PrEP demonstration study in SA (80.8%), we down-adjusted TAPS estimates for the proportion of FSWs with detectable drug levels (adjusted range: 38.0-70.4%). The model stratified FSW by low (undetectable drug; 0% efficacy) and high adherence (detectable drug; 79.9%; 95% CI: 67.2-87.6% efficacy). FSWs can transition between adherence levels, with lower loss-to-follow-up among highly adherent FSWs (aHR: 0.58; 95% CI: 0.40-0.85; TAPS data). The model was calibrated to monthly data on the national scale-up of PrEP among FSWs over 2016-2020, including reductions in PrEP initiations during 2020. The model projected the impact of the current programme (2016-2020) and the future impact (2021-2040) at current coverage or if initiation and/or retention are doubled. Using published cost data, we assessed the cost-effectiveness (healthcare provider perspective; 3% discount rate; time horizon 2016-2040) of the current PrEP provision. RESULTS Calibrated to national data, model projections suggest that 2.1% of HIV-negative FSWs were currently on PrEP in 2020, with PrEP preventing 0.45% (95% credibility interval, 0.35-0.57%) of HIV infections among FSWs over 2016-2020 or 605 (444-840) infections overall. Reductions in PrEP initiations in 2020 possibly reduced infections averted by 18.57% (13.99-23.29). PrEP is cost-saving, with $1.42 (1.03-1.99) of ART costs saved per dollar spent on PrEP. Going forward, existing coverage of PrEP will avert 5,635 (3,572-9,036) infections by 2040. However, if PrEP initiation and retention doubles, then PrEP coverage increases to 9.9% (8.7-11.6%) and impact increases 4.3 times with 24,114 (15,308-38,107) infections averted by 2040. CONCLUSIONS Our findings advocate for the expansion of PrEP to FSWs throughout SA to maximize its impact. This should include strategies to optimize retention and should target women in contact with FSW services.
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Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUK
| | - Rutendo Bothma
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Gabriela B. Gomez
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Robyn Eakle
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
- Office of HIV AIDSU.S. Agency for International Development (USAID)WashingtonDCUSA
| | - Christinah Mukandavire
- Population Health SciencesUniversity of BristolBristolUK
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | | | - Hannah Fraser
- Population Health SciencesUniversity of BristolBristolUK
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jenny Coetzee
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
- African Potential Management ConsultancyKyalamiSouth Africa
| | - Kennedy Otwombe
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Minja Milovanovic
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- African Potential Management ConsultancyKyalamiSouth Africa
| | - Stefan Baral
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | | | - Helen Rees
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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4
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Bothma R, O'Connor C, Nkusi J, Shiba V, Segale J, Matsebula L, Lawrence JJ, van der Merwe LL, Chersich M, Hill N. Differentiated HIV services for transgender people in four South African districts: population characteristics and HIV care cascade. J Int AIDS Soc 2022; 25 Suppl 5:e25987. [PMID: 36225147 PMCID: PMC9557019 DOI: 10.1002/jia2.25987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Transgender people in South Africa are disproportionately affected by HIV, discrimination and stigma. Access to healthcare and health outcomes are poor. Although integrating gender-affirming healthcare with differentiated HIV prevention, care and treatment services has shown improvement in HIV service uptake and health outcomes among transgender people, evidence is lacking on the implementation of differentiated service delivery models in southern Africa. This article describes a differentiated service delivery model across four South African sites and transgender individuals who access these services. We assess whether hormone therapy (HT) is associated with continued use of pre-exposure prophylaxis (PrEP) and viral load suppression. METHODS In 2019, differentiated healthcare centres for transgender individuals opened in four South African districts, providing gender-affirming healthcare and HIV services at a primary healthcare level. Routine programme data were collected between October 2019 and June 2021. Descriptive statistics summarized patient characteristics and engagement with HIV prevention and treatment services. We conducted a multivariate logistic regression analysis to determine whether HT was associated with viral load suppression and PrEP continued use. RESULTS In the review period, we reached 5636 transgender individuals through peer outreach services; 86% (4829/5636) of them accepted an HIV test and 62% (3535/5636) were linked to clinical services. Among these, 89% (3130/3535) were transgender women, 5% (192/3535) were transgender men and 6% (213/3535) were gender non-conforming individuals. Of those who received an HIV test, 14% (687/4829) tested positive and 91% of those initiated antiretroviral treatment. Viral load suppression was 75% in this cohort. PrEP was accepted by 28% (1165/4142) of those who tested negative. Five percent (161/3535) reported ever receiving HT through the public healthcare system. Service users who received HT were three-fold more likely to achieve viral load suppression. We did not find any association between HT and continued use of PrEP. CONCLUSIONS A differentiated HIV and gender-affirming service delivery model at a primary healthcare level is feasible and can enhance service access in South Africa. HT can improve HIV clinical outcomes for transgender people. As trust is established between the providers and population, uptake of HIV testing and related services may increase further.
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Affiliation(s)
- Rutendo Bothma
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Cara O'Connor
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Jolie Nkusi
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Vusi Shiba
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Jacob Segale
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Luyanda Matsebula
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - J. Joseph Lawrence
- United States Agency for International Development/Southern AfricaCity of TshwaneSouth Africa
| | | | - Matthew Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
| | - Naomi Hill
- Wits Reproductive Health and HIV Institute (Wits RHI)University of the WitwatersrandJohannesburgSouth Africa
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5
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Tomson A, McLachlan C, Wattrus C, Adams K, Addinall R, Bothma R, Jankelowitz L, Kotze E, Luvuno Z, Madlala N, Matyila S, Padavatan A, Pillay M, Rakumakoe MD, Tomson-Myburgh M, Venter WDF, de Vries E. Southern African HIV Clinicians' Society gender-affirming healthcare guideline for South Africa. South Afr J HIV Med 2021; 22:1299. [PMID: 34691772 PMCID: PMC8517808 DOI: 10.4102/sajhivmed.v22i1.1299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022] Open
Abstract
No abstract available.
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Affiliation(s)
- Anastacia Tomson
- My Family GP, Cape Town, South Africa.,Shemah Koleinu, Cape Town, South Africa
| | - Chris/Tine McLachlan
- KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.,Department of Psychology, College of Human Sciences, University of South Africa, Pretoria, South Africa.,Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Psychological Society of South Africa, Johannesburg, South Africa
| | - Camilla Wattrus
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Kevin Adams
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Department of Plastic Surgery, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Ronald Addinall
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Department of Social Development, Faculty of Humanities, University of Cape Town, Cape Town, South Africa.,Southern African Sexual Health Association, Cape Town, South Africa
| | - Rutendo Bothma
- Wits Reproductive Health Institute, Johannesburg, South Africa
| | | | - Elliott Kotze
- Psychologist, Independent Practice, Cape Town, South Africa
| | - Zamasomi Luvuno
- School of Nursing and Public Health, Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Nkanyiso Madlala
- Department of Psychology, College of Human Sciences, University of South Africa, Pretoria, South Africa.,Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Psychological Society of South Africa, Johannesburg, South Africa
| | | | | | - Mershen Pillay
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Department of Speech-Language Therapy, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Speech-Language Therapy, Faculty of Health Sciences, Massey University, Auckland, New Zealand
| | - Mmamontsheng D Rakumakoe
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Quadcare, Johannesburg, South Africa
| | | | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elma de Vries
- Professional Association for Transgender Health South Africa, Cape Town, South Africa.,Cape Town Metro Health Services, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
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Reza-Paul S, Lazarus L, Jana S, Ray P, Mugo N, Ngure K, Folayan MO, Durueke F, Idoko J, Béhanzin L, Alary M, Gueye D, Sarr M, Mukoma W, Kyongo JK, Bothma R, Eakle R, Dallabetta G, Presley J, Lorway R. Community Inclusion in PrEP Demonstration Projects: Lessons for Scaling Up. Gates Open Res 2019; 3:1504. [PMID: 31942537 PMCID: PMC6943951 DOI: 10.12688/gatesopenres.13042.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/23/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects worked to better engage communities and create spaces for community involvement in the planning and roll out of these projects. We describe the community engagement strategies employed by seven Bill & Melinda Gates Foundation-funded PrEP demonstration projects. Community engagement has emerged as a critical factor for education, demand generation, dispelling rumors, and supporting adherence and follow up in the PrEP demonstration project case studies. The increasing global interest in PrEP necessitates understanding how to conduct community engagement for PrEP implementation in different settings as part of combination HIV prevention.
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Affiliation(s)
- Sushena Reza-Paul
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Ashodaya Samithi, Mysore, India
| | - Lisa Lazarus
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Protim Ray
- Durbar Mahila Samanawaya Committee, Kolkata, India
| | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Florita Durueke
- New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria
| | - John Idoko
- Department of Medicine, University of Jos, Jos, Nigeria
| | - Luc Béhanzin
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Benin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Benin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada.,Département de médecine sociale et préventive, Université Laval, Quebec, Canada.,Institut national de santé publique du Québec, Quebec, Canada
| | - Daouda Gueye
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation (IRESSEF), Dakar, Senegal
| | | | | | | | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Robyn Eakle
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Robert Lorway
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
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7
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Reza-Paul S, Lazarus L, Jana S, Ray P, Mugo N, Ngure K, Folayan MO, Durueke F, Idoko J, Béhanzin L, Alary M, Gueye D, Sarr M, Mukoma W, Kyongo JK, Bothma R, Eakle R, Dallabetta G, Presley J, Lorway R. Community Inclusion in PrEP Demonstration Projects: Lessons for Scaling Up. Gates Open Res 2019. [PMID: 31942537 DOI: 10.12688/gatesopenres.13042.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects attempted to better engage communities and create spaces for community involvement in the planning and roll out of these projects. We briefly describe the community engagement strategies employed by seven Bill & Melinda Gates Foundation-funded PrEP demonstration projects and the lessons these projects offer for community engagement in PrEP implementation.
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Affiliation(s)
- Sushena Reza-Paul
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Ashodaya Samithi, Mysore, India
| | - Lisa Lazarus
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Protim Ray
- Durbar Mahila Samanawaya Committee, Kolkata, India
| | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Florita Durueke
- New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria
| | - John Idoko
- Department of Medicine, University of Jos, Jos, Nigeria
| | - Luc Béhanzin
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Benin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Benin
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada.,Département de médecine sociale et préventive, Université Laval, Quebec, Canada.,Institut national de santé publique du Québec, Quebec, Canada
| | - Daouda Gueye
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation (IRESSEF), Dakar, Senegal
| | | | | | | | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Robyn Eakle
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Robert Lorway
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, Canada
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8
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Eakle R, Bothma R, Bourne A, Gumede S, Motsosi K, Rees H. "I am still negative": Female sex workers' perspectives on uptake and use of daily pre-exposure prophylaxis for HIV prevention in South Africa. PLoS One 2019; 14:e0212271. [PMID: 30964874 PMCID: PMC6456175 DOI: 10.1371/journal.pone.0212271] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/30/2019] [Indexed: 12/13/2022] Open
Abstract
Women remain highly vulnerable to HIV infection in sub-Saharan Africa, with female sex workers (FSWs) facing some of the highest rates of HIV. Oral pre-exposure prophylaxis (PrEP) has the potential to reduce new infections among populations at highest risk and end-user perspectives of actual use in ‘real-world’ settings are critical to informing PrEP implementation. This paper presents findings from serial in-depth interviews (IDIs) conducted with FSW participants during the course of the Treatment And Prevention for Sex workers (TAPS) Demonstration Project in South Africa, exploring the lived experiences and perceptions of taking up and using PrEP. This research provides insight into risks and responsibilities facing FSWs perceived as prominent drivers in taking up and using PrEP, how PrEP was adopted to mitigate risk or ameliorate realities, and the characteristics of PrEP most valued, all of which are critical to consider in scale-up. Overall, distrust in the existence and/or efficacy of PrEP affected the motivation of women to come to the clinic and to maintain use. As one of the first reports of PrEP use among FSWs outside of a clinical trial setting, this research shows that it will be important to ensure accurate, relevant, and widespread messaging in communities to generate demand and support for PrEP.
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Affiliation(s)
- Robyn Eakle
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: ,
| | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Sanele Gumede
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keneilwe Motsosi
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Eakle R, Gomez GB, Naicker N, Bothma R, Mbogua J, Cabrera Escobar MA, Saayman E, Moorhouse M, Venter WDF, Rees H. HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: Results from a prospective observational demonstration project. PLoS Med 2017; 14:e1002444. [PMID: 29161256 PMCID: PMC5697804 DOI: 10.1371/journal.pmed.1002444] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/17/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Operational research is required to design delivery of pre-exposure prophylaxis (PrEP) and early antiretroviral treatment (ART). This paper presents the primary analysis of programmatic data, as well as demographic, behavioural, and clinical data, from the TAPS Demonstration Project, which offered both interventions to female sex workers (FSWs) at 2 urban clinic sites in South Africa. METHODS AND FINDINGS The TAPS study was conducted between 30 March 2015 and 30 June 2017, with the enrolment period ending on 31 July 2016. TAPS was a prospective observational cohort study with 2 groups receiving interventions delivered in existing service settings: (1) PrEP as part of combination prevention for HIV-negative FSWs and (2) early ART for HIV-positive FSWs. The main outcome was programme retention at 12 months of follow-up. Of the 947 FSWs initially seen in clinic, 692 were HIV tested. HIV prevalence was 49%. Among those returning to clinic after HIV testing and clinical screening, 93% of the women who were HIV-negative were confirmed as clinically eligible for PrEP (n = 224/241), and 41% (n = 110/270) of the women who were HIV-positive had CD4 counts within National Department of Health ART initiation guidelines at assessment. Of the remaining women who were HIV-positive, 93% were eligible for early ART (n = 148/160). From those eligible, 98% (n = 219/224) and 94% (n = 139/148) took up PrEP and early ART, respectively. At baseline, a substantial fraction of women had a steady partner, worked in brothels, and were born in Zimbabwe. Of those enrolled, 22% on PrEP (n = 49/219) and 60% on early ART (n = 83/139) were seen at 12 months; we observed high rates of loss to follow-up: 71% (n = 156/219) and 30% (n = 42/139) in the PrEP and early ART groups, respectively. Little change over time was reported in consistent condom use or the number of sexual partners in the last 7 days, with high levels of consistent condom use with clients and low use with steady partners in both study groups. There were no seroconversions on PrEP and 7 virological failures on early ART among women remaining in the study. Reported adherence to PrEP varied over time between 70% and 85%, whereas over 90% of participants reported taking pills daily while on early ART. Data on provider-side costs were also collected and analysed. The total cost of service delivery was approximately US$126 for PrEP and US$406 for early ART per person-year. The main limitations of this study include the lack of a control group, which was not included due to ethical considerations; clinical study requirements imposed when PrEP was not approved through the regulatory system, which could have affected uptake; and the timing of the implementation of a national sex worker HIV programme, which could have also affected uptake and retention. CONCLUSIONS PrEP and early ART services can be implemented within FSW routine services in high prevalence, urban settings. We observed good uptake for both PrEP and early ART; however, retention rates for PrEP were low. Retention rates for early ART were similar to retention rates for the current standard of care. While the cost of the interventions was higher than previously published, there is potential for cost reduction at scale. The TAPS Demonstration Project results provided the basis for the first government PrEP and early ART guidelines and the rollout of the national sex worker HIV programme in South Africa.
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Affiliation(s)
- Robyn Eakle
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Development, London School of Hygiene &Tropical Medicine, London, United Kingdom
- Department of Public Health Policy, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Gabriela B. Gomez
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Development, London School of Hygiene &Tropical Medicine, London, United Kingdom
- Amsterdam Institute for Global Health and Development, Department of Global Health, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Niven Naicker
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Judie Mbogua
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria A. Cabrera Escobar
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Michelle Moorhouse
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - W. D. Francois Venter
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Research, London School of Hygiene &Tropical Medicine, London, United Kingdom
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